Abstract Objective To retrospectively analyze the long-term survival, late adverse events, and prognostic factors in patients with locally recurrent nasopharyngeal carcinoma (NPC) after re-irradiation with intensity-modulated radiotherapy (IMRT). Methods From 2001 to 2010, a total of 335 patients who were diagnosed with locally recurrent NPC and received re-irradiation with IMRT were included in the study. Among all the patients, 69(20.6%) had radiotherapy complications. There were 268 male patients (80.0%) and the median age was 45.0 years (range:21－75 years). The numbers of patients in disease stages T1, T2, T3, and T4 were 41, 36, 122, and 136, respectively. The median tumor volume was 37.5 cm3, and the median prescribed dose to the target volume was 68 Gy (range:60－70 Gy). The survival rate was determined using the Kaplan-Meier method. Prognostic factors were analyzed by the Cox proportional hazard model. Results The 5-year follow-up sample size was 290 patients. The 5-year overall survival, local-regional failure-free survival, and distant failure-free survival were 34.7%,64.2%, and 82.2%, respectively. Multivariate analysis indicated that the poor prognostic factors included age>45 years (P=0.01), presence of significant radiotherapy complications before IMRT (P=0.00), tumor stages (T2-T4)(P=0.00), tumor volume>38 cm3(P=0.01), and the mean dose of gross tumor volume (GTVnx)>68 Gy (P=0.01). The incidence rates of nasopharyngeal mucosa necrosis, epistaxis, radiation encephalopathy, cranial nerve injury, and trismus were 28.6%, 16.4%, 22.4%, 15.8%, and 13.7%, respectively. Conclusions Re-irradiation with IMRT is effective in controlling tumor and thus is a reasonable choice for patients with locally recurrent NPC. However, the incidence of severe adverse events is still high. Further investigation on how to maintain the balance between tumor control and normal organ protection is needed.
Corresponding Authors:
Han Fei,Department of Radiation Therapy, Cancer Hospital of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou 510060, China;Email:hanfei@sysucc.org.cn
Cite this article:
Tian Yunming,Bai Li,Xiao Weiwei et al. Evaluation of long-term efficacy of re-irradiation with intensity-modulated radiotherapy for locally recurrent nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 168-173.
Tian Yunming,Bai Li,Xiao Weiwei et al. Evaluation of long-term efficacy of re-irradiation with intensity-modulated radiotherapy for locally recurrent nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 168-173.
[1]Lee AW, Poon YF and Foo W, et al. Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976－1985:overall survival and patterns of failure[J]. Int J Radiat Oncol Biol Phys,1992,23(5):261-270. [2]Leung TW, Tung SY, Sze WK, et al. Treatment results of 1070 patients with nasopharyngeal carcinoma:an analysis of survival and failure patterns[J]. Head Neck,2005,27(7):555-565. [3]Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience[J]. Int J Radiat Oncol Biol Phys,2002,53(1):12-22. [4]赵充,肖巍魏,韩非,等.419例鼻咽癌调强放疗疗效和影响[J].中华放射肿瘤学杂志,2010,19(3):191-196. DOI:10.3760/cma.j.issn.1004-4221.2010.03.005 [5]Yu KH, Leung SF, Tung SY, et al. Survival outcome of patients with nasopharyngeal carcinoma with first local failure:a study by the Hong Kong nasopharyngeal carcinoma study group[J]. Head Neck,2005,27(5):397-405. [6]Oksuz DC, Meral G, Uzel O, et al. Reirradiation for locally recurrent nasopharyngeal carcinoma:treatment results and prognostic factors[J]. Int J Radiat Oncol Biol Phys,2004,60(2):388-394. [7]Teo PM, Kwan WH, Chan AT, et al. How successful is high-dose (>or=60 Gy) reirradiation using mainly external beams in salvaging local failures of nasopharyngeal carcinoma?[J].Int J Radiat Oncol Biol Phys,1998,40(4):897－913 [8]Xia P, Fu KK, Wong GW, et al. Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys,2000,48(2):329-37. [9]Hsiung CY, Yorke ED, Chui CS, et al. Intensity-modulated radiotherapy versus conventional three-dimensional conformal radiotherapy for boost or salvage treatment of nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys,2002,53(3):638-47. [10]Lu TX, Mai WY, Teh BS, et al. Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys,2004,58(3):682-687. [11]Chua DT, Sham JS, Leung LH, et al. Re-irradiation of nasopharyngeal carcinoma with intensity-modulated radiotherapy[J].Radiother Oncol,2005,77(3):290-294. [12]Hua YJ, Han F, Lu LX, et al. Long-term treatment outcome of recurrent nasopharyngeal carcinoma treated with salvage intensity modulated radiotherapy[J]. Eur J Cancer,2012,48(18):3422-3428.DOI:10.1016/j.ejca.2012.06.016. [13]韩非,卢泰祥,赵充,等.放疗后局部复发的鼻咽癌调强放疗的预后分析[J].中华放射肿瘤学杂志,2006,15(4):244-248. [14]Nieder C, Milas L, Ang KK. Tissue tolerance to reirradiation[J]. Semin Radiat Oncol,2000,10(3):200-209. [15]Pignon JP, le Maitre A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC):an update on 93 randomised trials and 17,346 patients[J]. Radiother Oncol,2009,92(1):4-14.DOI:10.1016/j.radonc.2009.04.014. [16]Lee AW, Foo W, Law SC, et al. Reirradiation for recurrent nasopharyngeal carcinoma:factors affecting the therapeutic ratio and ways for improvement[J]. Int J Radiat Oncol Biol Phys,1997,38(1):43-52. [17]Weichselbaum RR, Beckett MA, Schwartz JL, et al. Radioresistant tumor cells are present in head and neck carcinomas that recur after radiotherapy[J]. Int J Radiat Oncol Biol Phys,1988,15(3):575-579. [18]Wang CC. Re-irradiation of recurrent nasopharyngeal carcinoma—treatment techniques and results[J]. Int J Radiat Oncol Biol Phys,1987,13(7):953-956. [19]McDonald MW, Moore MG, Johnstone PA. Risk of carotid blowout after reirradiation of the head and neck:a systematic review[J]. Int J Radiat Oncol Biol Phys,2012,82(3):1083-1089.DOI:10.1016/j.ijrobp.2010.08.029. [20]Hua YJ, Chen MY, Qian CN, et al. Postradiation nasopharyngeal necrosis in the patients with nasopharyngeal carcinoma[J]. Head Neck,2009,31(6):807-812.DOI:10.1002/hed.21036. [21]Koutcher L, Lee N, Zelefsky M, et al. Reirradiation of locally recurrent nasopharynx cancer with external beam radiotherapy with or without brachytherapy[J]. Int J Radiat Oncol Biol Phys,2010,76(1):130-137.DOI:10.1016/j.ijrobp.2009.01.055. [22]Ozyigit G, Cengiz M, Yazici G, et al. A retrospective comparison of robotic stereotactic body radiotherapy and three-dimensional conformal radiotherapy for the reirradiation of locally recurrent nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys,2011,81(4):263-268.DOI:0.1016/j.ijrobp.2011.02.054. [23]Poon D, Yap SP, Wong ZW, et al. Concurrent chemoradiotherapy in locoregionally recurrent nasopharyngeal carcinoma[J]. Int J Radiat Oncol Biol Phys,2004,59(5):1312-1318. [24]Chua DT, Sham JS, Au GK. Induction chemotherapy with cisplatin and gemcitabine followed by reirradiation for locally recurrent nasopharyngeal carcinoma[J]. Am J Clin Oncol,2005,28(5):464-471. [25]Chan AT, Hsu MM, Goh BC, et al. Multicenter, phase Ⅱ study of cetuximab in combination with carboplatin in patients with recurrent or metastatic nasopharyngeal carcinoma[J]. J Clin Oncol,2005,23(15):3568-3576.
2015, Vol. 24 
